This promising 25-item CKD-SE instrument can be used for the early identification of patients with low DSE, thus allowing the development of interventions to help these patients attain an appropriate level of DSE.

With its evident structural and functional advantages, fasciocutaneous flaps were suitable for larger scalp defect only and myocutaneous flaps can be considered as an excellent reconstructive option for complicated scalp and calvarial defects, especially where dead space coexists.

Traumatic wounds inflict small- and large-fiber sensory nerve damage, causing neuropathic pain in scar tissue, thus impairing patients' quality of life and leading to the development of psychological disorders. Autologous fat grafting has been clinically shown to improve scar quality, but few studies have explored the effects of this technique on pain. The purpose of this study was to assess the effect of fat grafting on treating neuropathic scar pain. From February 2008 to January 2013, 13 patients who were identified using the Douleur Neuropathique 4 Questions (scores>4/10) were enrolled in this study. The Visual Analog Scale (VAS) and Neuropathic Pain Symptom Inventory (NPSI) were used to evaluate pain preoperatively and 1 week, 4 weeks, and 24 weeks postoperatively. The mechanism of trauma, scar location and size, duration of allodynia, fat graft volume, pharmacologic therapy duration, and total follow-up time were recorded. Thirteen patients experiencing neuropathic pain were enrolled in this study. The mean±SD age was 33.08±16.35 years. The mean duration of pain was 4.29±2.85 months. The mean VAS score before treatment was 7.54±1.05. The mean VAS scores decreased by 4.38±1.66 after 1 week of treatment (P=0.009), 5.38±2.06 after 4 weeks of treatment, and 5.62±2.18 after 24 weeks of treatment. The mean NPSI scores were 49.38±13.25 before treatment, 25±14.4 after 1 week of treatment (P=0.004), 21±17.78 after 4 weeks of treatment, and 14.62±16.88 after 24 weeks of treatment. The 13 patients followed a mean of 24 weeks; 10 (77%) of the patients had improvement of 5 or greater on the VAS score. The mean follow-up period was 19.3±12.26 months (range, 6-38 months). No surgical complications were noted in this series. In our study, both VAS and NPSI scores decreased significantly, revealing that the autologous fat grafting can alleviate neuropathic scar pain 1 week after operation and in the long term.

MPAP flaps are good in terms of general morbidity, cosmetic results, and durability. This flap is a valuable alternative method of repairing the glabrous finger pulp and tip defects.

The combination of peripheral arterial intervention and free tissue transfer resulted in successful wound healing and limb salvage instead of amputation in select diabetic patients with difficult-to-heal wounds.

Secreted protein acidic and rich in cysteine (SPARC) is a secreted protein which is involved in various biological processes. SPARC expression is associated with tumor metastasis and poor prognosis in several types of cancer. However, the SPARC-induced signaling pathway was not fully understood in head and neck cancer. In this study, our results showed that SPARC treatment promoted cell proliferation and migration in head and neck cancer cell lines FaDu and Detroit 562. In addition, SPARC induced expression of epithelial mesenchymal transition (EMT) regulators, including Slug, Snail, and Twist in Detroit 562. The results of phospho-kinase array analysis showed that SPARC treatment increased phosphorylation of some molecules including protein kinase B (PKB/AKT), ribosomal S6 kinase (RSK), and extracellular signal–regulated kinases (ERK). The expression of SPARC-induced EMT regulator Slug was suppressed by AKT inhibitor, but not ERK and RSK inhibitors. The SPARC expression in grade IV tumor samples is higher when compared to that in grade I–III tumor samples. Our results suggest that SPARC treatment enhances the EMT signaling pathway via activation of AKT, and exogenous SPARC and tumor expressing SPARC might be associated with tumor progression in head and neck cancers.

Extracorporeal shockwave therapy (ESWT) has a significant positive effect to accelerate chronic wound healing. This study investigated whether the vascular endothelial growth factor (VEGF)–related pathway has involved in ESWT enhancement of diabetic wound healing. A dorsal skin defect (area, 6 × 5 cm) in a streptozotocin‐induced diabetes rodent model was used. Thirty‐two male Wistar rats were divided into four groups. Group I consisted of nondiabetic control; group II, diabetic control without treatment; group III, diabetic rats received ESWT; and group IV, rats received Avastin (a VEGF monoclonal antibody) on day 0 (post‐wounding immediately) to day 7 and ESWT on day 3 and day 7. The wound healing was assessed clinically. The VEGF, endothelial nitric oxide synthase (eNOS), and Ki‐67 were analyzed with immunohistochemical staining. The mRNA expression of mitogen‐activated protein kinase–related genes was measured by real‐time quantitative real‐time polymerase chain reaction. The results revealed wound size was significantly reduced in the ESWT‐treated rats as compared to the diabetic control (p < 0.01). The positive effect of ESWT‐increasing wound healing was significantly suppressed in pretreatment of the Avastin group. Histological findings revealed significant increase in neo‐vessels in the ESWT group as compared to the control. In immunohistochemical stain, significant increases in VEGF, eNOS, and Ki‐67 expressions were noted in the ESWT group as compared to that in controls. However, Avastin suppressed the shockwave effect and down‐regulation of VEGF, eNOS, and Ki‐67 expressions in the Avastin‐ESWT group as compared to that in the ESWT alone group. We found that highly mRNA expression of Kras, Raf1, Mek1, Jnkk, Jnk, and Jun at early stage in the ESWT group, as compared to the diabetic control. These evidences indicated treatment with multiple sessions of ESWT significantly enhanced diabetic wound healing associated with increased neovascularization and tissue regeneration. The bio‐mechanism of ESWT‐enhanced wound healing is correlated with VEGF and mitogen‐activated protein kinase–mediated pathway.

Porcine mesenchymal stem cells have been isolated previously from bone marrow but not from adipose tissue. In the present study a new cell-culture method, using a low-calcium medium supplemented with N-acetyl-L-cysteine and L-ascorbic acid 2-phosphate (the PM2 medium) was developed to grow pASCs (porcine adipose-tissue-derived stem cells). The pASCs developed using the new medium showed a high growth rate and a high proliferation potential, as measured by a cumulative population doubling level (55) that was significantly higher than those reported for ASCs in the literature. These pASCs lacked gap-junctional intercellular communication and were capable of differentiation into three mesodermal lineages (i.e. adipocytes, osteoblasts and chondrocytes) and an ectodermal lineage (i.e. neural cells). Surprisingly, osteogenic ability, but not adipogenesis, was found to increase dramatically with increasing passages. The high proliferative and differentiation potential of these pASCs should facilitate the development of a large-animal model to study the use of ASCs in regenerative and reparative medicine.